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Posted by on Nov 22, 2022 in Lung cancer | 0 comments

In a nutshell

This study evaluated the effectiveness and safety outcomes of atezolizumab (Tecentriq) alone or with tiragolumab (MTIG7192A) as a first-line treatment for patients with non-small cell lung cancer (NSCLC). The data showed that tiragolumab plus atezolizumab significantly improved the objective response rate and the survival without cancer worsening compared to atezolizumab alone in these patients.

Some background

Non-small cell lung cancer (NSCLC) is the most common form of lung cancer. NSCLC is responsible for around 85% of all lung cancer diagnoses. Standard treatment for advanced NSCLC involves surgical removal of solid tumors, chemotherapy, and radiotherapy. Despite current treatment options improving survival rates, advanced NSCLC can be difficult to treat.

Immunotherapy has been found to be effective in advanced NSCLC. PD-L1 is a protein that can be found in high numbers on cancer cells. It shuts down the immune system so that cancer cells can grow and spread without detection. Atezolizumab is an immunotherapy that targets PD-L1. Blocking PD-L1 restores the capacity of the immune system to attack and kill cancer cells. Tiragolumab is an experimental drug. It targets a protein called TIGIT. TIGIT is involved in how immune cells respond to cancer cells. Blocking TIGIT may improve the immune system's ability to detect and kill cancer cells.

Atezolizumab as a first-line treatment has been found to significantly improve the outcomes of patients with advanced NSCLC. However, the effectiveness and safety of atezolizumab plus tiragolumab versus atezolizumab alone as a first-line treatment for patients with PD-L1 positive NSCLC (presence of PD-L1 protein on cancer cells) are still under investigation.

Methods & findings

This study involved 135 patients with PD-L1-positive recurrent or metastatic NSCLC. Patients were divided into 2 groups. Group 1 included 67 patients who received tiragolumab plus atezolizumab. Group 2 included 68 patients who received atezolizumab alone. The average follow-up time was 5.9 months.

The objective response rate (ORR; partial or complete disappearance of cancer cells) was 31.3% in group 1 compared to 16.2% in group 2.

The average survival without cancer worsening was 5.4 months in group 1 compared to 3.6 months in group 2. Patients in group 1 were 43% more likely to have a better survival without cancer worsening than patients in group 2.

Treatment-related side effects were similar between the 2 groups (21% in group 1 vs 18% in group 2). The most common side effect was an increase in the enzyme lipase (inflammation of the pancreas).

The bottom line

This study concluded that tiragolumab plus atezolizumab significantly improved response rate and the survival without cancer worsening compared to atezolizumab alone for patients with PD-L1 positive NSCLC.

The fine print

This study was funded by F Hoffmann-La Roche and Genentech, the manufacturer of tiragolumab. The sample size was very small and the follow-up time was too short. Longer-term studies are needed to validate these findings. 

Published By :

The Lancet. Oncology

Date :

May 13, 2022

Original Title :

Tiragolumab plus atezolizumab versus placebo plus atezolizumab as a first-line treatment for PD-L1-selected non-small-cell lung cancer (CITYSCAPE): primary and follow-up analyses of a randomised, double-blind, phase 2 study.

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